† Brunt does not require ballooning to be present to call steatohepatitis;[4] however, a table in a later paper Brunt paper (surveying pathologists) suggest that a significant number of pathologist may consider it a required finding.[5]

Cirrhosis with steatohepatitis in a 54 year old man with type II diabetes, negative viral serologies, negative alcohol history, negative AMA/ANA, normal ceruloplasmin, low albumin/platelet count, and elevated bilirubin/alkaline phosphatase/transaminase, with hepatosplenomegaly. A. At lower power, no definite triads are seen, but there are potential bands (green arrows) and foci with steatosis (blue arrows). The low percent of hepatocytes afflicted by steatosis would indicate a Brunt necroinflammatory grade 1, here irrelevant as cirrhosis is present. B. Tufts (green arrows) prove ballooning degeneration needed for a diagnosis of steatohepatitis. Foamy macrophage-like hepatocytes (blue arrows) show feathery degeneration is also present. C. Reticulin shows two cell thick cords (green arrows) of regeneration. D. Trichrome shows blue bands and definite nodules (white arrows). At one time, 75% of the biopsy would have had to have been occupied to diagnose cirrhosis. Currently, under the Metavir system, one need only have extensive fibrosis, which would include developing cirrhosis of the HAI system, to obtain a grade IV status, acceptable for transplantation.

Fibrosis stage 0 Brunt necroinflammatory grade 1 (WC)

Necroinflammatory grades Brunt 1, NAH 3. Fibrosis stage 0. About 25% of the liver shows steatosis (UL), not pan-acinar. Only rarely identified were either ballooned hepatocytes or inflammatory aggregates. UR shows more macrovesicular (blue arrowhead) than microvesicular (yellow arrowhead) steatosis, with occasional neutrophils in acini ( tip of green arrowhead, benath inflammatory aggregate, with tuft of material in ballooned hepatocyte at base of green arrow), and many glycogenated nuclei (magenta arrowhead). Additional evidence of hepatocellular damage is seen on the reticulin with focal zone III collapse (LL, blue arrowhead) and on the PAS with diastase stain with PAS-D Kupffer cells (LR black arrowheads)